Asymptomatic Double Aortic Arch and Symptomatic Coronary Artery Disease in an Elderly Patient - An Unusual Combination

A 60-year-old female patient presented with acute onset of retrosternal chest pain to the emergency room. On investigating, she was found to have ST segment depression in leads V1-V5 in Electrocardiogram (ECG), positive cardiac enzymes and upper mediastinal widening on chest X-ray (CXR). Magnetic Resonance Aortogram (MRA) revealed a double aortic arch where both the right as well as left arches were functional and balanced. Coronary angiogram showed significant block of left circumflex artery for which a successful percutaneous stent placement (PTCA) was done. Thus, the patient had acute coronary syndrome for which she was treated successfully. A balanced or co-dominant type of double aortic arch which is an uncommon congenital cardiac anomaly was an incidental finding.